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More than two-thirds (68%) of managers and clinicians from GP practices and PCTs believe that practice boundaries should not be extended, according to a survey conducted by NHS Alliance.

An even higher proportion – 77% – believe that, if boundaries were to be extended, extra funding would be required.

And the vast majority (91%) said that practice catchment areas should continue to be used to identify patients for whom the practice has a duty to provide home visits where necessary.

The NHS Alliance says that, while improving access to primary care and general practice is to be commended, government plans to extend GP boundaries raise serious questions about funding, continuity of care, risk of mismanagement and clinical error as well as health inequalities.

Chiming with a report issued by the British Medical Association yesterday (26 January 2010), which said the introduction of practice boundaries could incur a "huge cost and upheaval", the NHS Alliance said that any move towards boundaries extension should not lose sight of the importance of continuity of care and personalised care that patients currently receive in their local practices.

"In particular, it could lead to some practices having to close their lists for local patients and, for those who can register with local practices, there could be a danger that personal care and continuity for those that most need it – the elderly, the long-term ill and the very sick – is fractured.

"At worst, we could end up with some practices cherry-picking the less ill and more remunerative patients, leaving those most in need of heavy duty care being unable to get it. In short, the drive to greater choice might lead, especially for the most vulnerable, to a narrower range of options."

Dr Dixon added: "The best people to orchestrate the extension of GP boundaries are the PCTs, local practices and the local population. The NHS Alliance believes categorically that where PCTs find access to GP practices to be a major issue of concern, they should work with local practices and patients to address it."